Question
My CD4 count seems to be dropping. What can I do?
5 November 2010. Related: All topics, CD4 and viral load, Starting treatment.
I tested positive in February 2010. My viral load was 10,000 and CD4 count was 231, two weeks later my viral load was 12,000 and CD4 count was 224. The readings were the same at the end of March.
I started on Atripla in April. Reading from the end of April was inconclusive as the blood sample wasn’t handled correctly. In July viral load was undetectable and CD4 count of 265. Results in November, from my most recent blood sample was that viral load was undetectable but CD4 count was 229, down below my very first reading.
Is there a reason my CD4 count would decrease? My doctor wasn’t overly concerned saying that it takes longer for the CD4 count to rise when starting from a low number but I am concerned. A slow rise in CD4 count would be one thing but a regression seems more serious to me.
I don’t drink alcohol, smoke or take drugs, have a good balanced diet and take regular exercise. I feel well and haven’t been sick since starting the treatment. Might my CD4 count stay permanently low or could it continue to decrease, even if my viral load stays undetectable? Is there anything I should try to do to try to boost my CD4 count? What might be the implications of a permanently low CD4 count even if my viral load remains undetectable? Apologies for the long-winded question and many thanks for your help.
Answer
Thank you for your question.
Please do not worry. It is normal for CD4 counts to fluctuate. Although your CD4 count appears to be decreasing the differences are very small between the figures and could be seen as remaining quite stable. The slight fluctuation could be as a result of many things including the time of day you tested, how much exercise you did before the test, how tired/stressed you are etc.
For more information about fluctuating CD4 counts please follow this link
Your doctor is correct that your CD4 count will take longer to increase once you have started treatment. Some people can take over a year on treatment before their CD4 count starts to increase.
Unfortunately there is little you can do to increase your CD4 count aside from taking ARVs. When you are on treatment the most important thing to monitor is your viral load which, now that you are on treatment, should remain undetectable.
Hi Magdeline,
How have you been since you were diagnosed? Have you had any health problems? If you haven’t that’s great news, given that your CD4 was so low.
In response to your quesiton, ideally you should have had your CD4 checked last time you were in clinic. Therefore, if you can I would to have it checked. The ARVs are working however, because your viral load is undetectable.
I was diagnosed with a CD4 of 1 last August. I started Alluvia straight away. I went back to clinic in January and was told that my viral load was undetectable. When should I have my CD4 tested again?
Hi Bokang,
Are you sure your viral load is 1180? This is very low for someone who is new to ART, and who has a low CD4.
With regards to how long it will, or should take for your viral load to become undetectable, please see here:
http://i-base.info/qa/4669
Its not possible to say how long it will take for your CD4 to increase to normal levels. This is because it varies from person to person. It will though go up with ART.
Because you’re new to treatment, you may find this guide helpful:
http://i-base.info/guides/starting
Hi, I’ve started my HIV treatment …my CD4 is 143 and my viral load is 1180.This is my 8th day of taking ART. How long will it take for my viral load to drop and for my CD4 to increase?
Hi Molly,
CD4’s can and do flucuate, therefore because your viral load is undetectable its probably nothing to worry about. If, however you are worried, please have your CD4 retested. For more info please see here:
http://i-base.info/qa/424
My viral load is undetectable, but my CD4 has dropped from 456 to 351.
Hi Cynthia,
How long have you been on treatment? What are you taking? What is your CD4 count? What have your viral load results been since you tested positive? If you could get back to us, I’ll be able to help you.
Hi I’m Hiv positive I’m taking my treatment daily. But I go to the clinic, they said my viral load is very high, I don’t understand because I’m also condomise…what is happening?
Hi Kofi, I am sorry to hear that your sister has such a difficult time. If the previous HIV drugs were not working, then the new combination is likely to make a big difference. Without know the names of the drugs it is difficult to comment, but there is a good chance that her CD4 count will get higher again. It is good that different experts are involved in different aspects of your sister’s care. It is also important that these experts talk to each other.
Hi! My sister was diagnosed as HIV+ in December 2014. She was also diagnosed to be suffering from Toxoplasmosis and had a brain lesion. She was put on ARV treatment and also a treatment for the toxoplasmosis. She took her ARV drugs religiously and never missed any appointment with her doctor. In August this year, her cd4 count was found to have dropped to 13. She fell into comma for about 36 hours. After a brain scan she was put on sulfadiazine-daraprim-folic acid treatment from six weeks which just ended. One of her two ARV drugs was also changed. Do we expect her cd4 count to increase soon? We also realize her weight which was building up has started to drop and the improvement in her outlook seems to have stalled. Different hospitals and doctors are handling the ARV and toxoplasmosis treatments.